Individual
JOHN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 BELLINGER ST, EAU CLAIRE, WI 54703-5222
(715) 838-5222
Mailing address
1400 BELLINGER ST, EAU CLAIRE, WI 54703-5222
(715) 838-5222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25304-20
WI
207P00000X
Emergency Medicine Physician
MD10574
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149120
—
OR
01
—
208973
WA L & I
—
05
—
8142002
—
WA
01
—
858543009
REGENCE BCBS
—
01
—
P00232007
RAILROAD MEDICARE
—
Enumeration date
04/10/2006
Last updated
01/17/2023
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